"Gaza health care on the brink of collapse,” “the health catastrophe in Gaza,” “total collapse of Gazan health care 'imminent’…” The world has seen many headlines about how the Gazan health case is near complete implosion.

These warnings are not new. They go back as far as 2007, when the siege was first imposed on Gaza by Israel, after Hamas took control of the small enclave of land.

Slow deterioration

Already in December 2007, the United Nations warned about negative effects of the blockade, stating that 25% of essential drugs and 34% of the essential medicinal supplies were at zero stock.

In 2009, the International Committee of the Red Cross (ICRC) saidGazan health care services cannot provide treatment to people who suffer from serious diseases, saying 1.5 million people were “trapped in despair.”

In 2010, the same organisation released a press statement titled “Gaza closure: not another year!” It stated the medicine supplies are at an all-time low. Chemotherapy and haemophilia drugs were unavailable, repeating the closure was having a devastating impact on the 1.5 million people in Gaza, and stating “the quality of health care in Gaza reached an all-time low.”

In 2011, Hassan Khalaf, deputy health minister in Gaza told the Electronic Intifada “during the first years of the siege, we could still manage, but nowadays, we have no alternatives.”

Seven years later, May 2018, a report released by rights group Physicians for Human Rights (PHR) quotes a Medical Supply Manager at Nasser hospital in Khan Younes.

He said; “we keep improvising, reusing the same supplies over and over again. Cleaning and reusing disposable equipment. (…) We’ve been using expired medicines.”

“Health care was much better before the blockade,” Naji Mahmoud, who lives in Gaza, told Palestine Monitor. “Around 90% of medicine was available, we had the medical machines and equipment. Now, there are so many types of medicine that are not present in Gaza at all.”

Mahmoud explained that sometimes medicine is available, but needs to be purchased in private pharmacies at very high prices. His younger brother was diagnosed with cancer two months ago. “He needs chemotherapy every 15 days. We have to pay it out of our own pocket, and it’s 900 Israeli shekel (approximately US$250) every session.”

Mahmoud equally explained that there are many people in Gaza with kidney failure, but only very few machines that perform dialysis. This means that hundreds of people need to use one machine. “Everybody needs to wait their turn,” he clarified.

“The same goes for X-rays,” he added. “Al Aqsa hospital is supposed to provide services for Maghazi Camp, Nuseirat Camp, Al Bureij, Al Zuwayda, Al Masdar and Deir Al Balah. But it does not have an X-ray scan.

“So people have to go to the European Hospital in Khan Younis or Al Shifa Hospital in Gaza city,” he said, emphasising how large amounts of people are forced to wait their turn until they can have an X-ray. “And sometimes the scans break down for one or two weeks,” he added.

Infrastructure

The siege’s negative effects on Gaza reaches beyond only a lack of medical equipment and medicine. “In the last 11 years, the hospitals have not expanded, while the population has become much more,” Mahmoud explained.

“During the wars, people had to sleep on the floors because there were not enough beds,” he said, referring to Israeli bombing campaigns on Gaza in 2008, 2012 and 2014. “It was bad, because the hospitals are not clean.”

Mahmoud recalled how the Israelis were shelling his house in 2014. He and his family ran to Al Aqsa Hospital. When they arrived at the hospital, the hospital was also bombed. “The Israelis obliterated an entire section,” he said, indicating that the hospitals are further damaged by Israeli military campaigns on the Gaza Strip.

Fuel and electricity crisis

Other than the shortages in medicine, equipment and bad infrastructure, the health care crisis is further exacerbated by the fuel and electricity crisis afflicting Gaza. April last year, the Palestinian Authority stopped paying electricity for the besieged Strip, and Gaza’s sole power plant ran out of fuel in the same time period.

February this year, the United Nations published a warning saying that health facilities in Gaza might need to be shut down soon because the fuel that runs the hospital’s generations is running out. Generators had already stopped working at three of Gaza’s 13 hospitals and 14 of its 54 medical centres.

Exit permits

Mahmoud explained that given the intolerable circumstances in Gaza’s health sector, people who get sick, systematically need referrals outside of Gaza. “But this is difficult,” he added, “not only to receive an exit permit, but also to coordinate the trip through the checkpoint.”

2017 was recorded by Human Rights Watch (HRW) to be an all-time low in the medical exit permits. The organisation stated that 54 persons died last year, waiting for permission to receive medical treatment outside Gaza.

PHR has documented that the Israeli intelligence makes exit permits conditional, saying Palestinians have to collaborate with them or else they cannot leave. The rights group released reports on this issue in 2008, and 2011.

Mental health

UNRWA wrote; “across the Gaza Strip, psychological trauma, poverty and environmental degradation have had a negative impact on residents’ physical and mental health; many, including children, suffer from anxiety, distress and depression.”

“Not everybody finds help [dealing with psychological trauma],” Mahmoud said. He told Palestine Monitor that the Red Cross does some meetings, “but only for people with amputated limbs.”

“And UNRWA does meetings for children,” he added.

“Other people don’t receive mental health services, or support when it comes to trauma. Because services are not there, others don’t feel they have the need,” he concluded.